OBJECTIVETo investigate the effectiveness of microbubble-enhanced ultrasound (MEUS) for detecting perforators preoperatively in supraclavicular flap surgery.

METHODSFrom May 2009 to October 2013, there were 20 patients (26 flaps were involved) who planned to undergo supraclavicular artery based flap surgeries to recover the large-area defects in head and neck. The MEUS together with regular color Doppler ultrasound ( CDUS) were conducted preoperatively to determine the anatomical features of perforators branching from supraclavicular arteries (SCA). The perforator with wider caliber, faster flow speed, longer pedicles and closer pivot point was selected and the flap was designed according to the observed results.

RESULTSThere were 37 perforators of SCA detected by CDUS, whose calibers were ranging from 0.5 to 0.8 mm [Mean: (0.6 ± 0.1) mm]. There were 48 perforators of SCA detected by MEUS. Compared to CDUS, the caliber obtained from MEUS for same vessel is significantly increased [(0.7 ± 0.3) mm vs (0.6 ± 0.1) mm, P < 0.05]. According to the results of MEUS and three-dimensional reconstructive techniques, in at least 65.4% (17/26) of the flaps, thoracic branch of SCA (TBSA) has large caliber and good flow velocity which can be regarded as the predominant vessel and used as the pedicle of flap. The results of the operations confirmed the existences of all the marked vessels. 25 flaps were obtained according to the preoperative plans and one case used perforators of internal mammary artery as free flaps since the perforator of SCA was found improper. The contrast-related complication occurred in one patient which was manifested by gastrointestinal adverse effect like nausea and anorexia. The patient recovered 1 day later without treatment. All the patients have been followed up for 3 to 16 months (Mean: 8 months) with well-survived flaps.

CONCLUSIONSThe perforators of SCA demonstrated significant variations and preoperative mapping was vital for the success of surgery. MEUS is a valuable imaging modality for the preoperative assessment of the vascular supply for supraclavicular artery based flap.

Arteries ; diagnostic imaging ; Humans ; Mammary Arteries ; Microbubbles ; Neck ; surgery ; Perforator Flap ; Reconstructive Surgical Procedures ; Ultrasonography ; methods

This study aimed to determine factors that influence blood flow through coronary bypass grafts and to analyze relationship between the graft flow and postoperative outcome. Blood flow through 146 bypass grafts(GBF) was measured with transit-time ultrasound flowmeter during coronary artery bypass grafting operations in 50 patients. Single and multiple regression analyses were done for relationships between the GBF and four variables: internal diameter of recipient coronary artery, myocardial value of bypassed branch(es), type of graft, and finding of preoperative myocardial perfusion scan. The relationship between GBF and postoperative scan finding was also analyzed. 1. The mean GBF was significantly higher in sequential grafts than in single vein grafts or in internal thoracic artery grafts(61.5 vs. 46.9 and 42.5 ml/min). 2. Myocardial value and recipient artery diameter were found to be the factors determining GBF. There was no correlation between GBF and presence of perfusion defect in the preoperative scan. 3. Myocardial value was found to be more important than recipient artery diameter in determinintg GBF. 4. Reversible perfusion defects were more frequently found in the areas supplied by grafts with low GBF. But this fact had only mild statistical significance. These results suggest that blood flow through a bypass graft is more determined by the size of its supplying myocardium than by the size of recipient artery. So, we can expect effective improvement in myocardial flow reserve after grafting of small(1~1.5mm) coronary arteries, if they supply substantial area of myocardium.
Arteries ; Coronary Artery Bypass* ; Coronary Vessels* ; Flowmeters ; Humans ; Mammary Arteries ; Myocardium ; Perfusion ; Regional Blood Flow ; Transplants ; Ultrasonography ; Veins

OBJECTIVE: The aim of this study is to evaluate the clinical characteristics and ultrasonographic findings of band-like interposing fat as well as to identify additional approaches for its diagnosis. MATERIALS AND METHODS: This study included 26 confirmed cases of band-like interposing fat from June 2008 to June 2010. A retrospective analysis was performed to evaluate the clinical characteristics and ultrasonographic findings in these cases. Five radiologists analyzed the ultrasonographic findings, which correlated with the mammographic and MRI findings when available, according to Breast Imaging Reporting and Data System classification. RESULTS: None of the 26 patients had any symptoms. In 92.3% of the patients, the lesion was located in the upper outer quadrant of the breast. The mean distance of the lesion from the nipple was 2.4 +/- 0.7 cm (1.1-4.5). The mean depth of the lesion from the skin was 1.3 +/- 0.3 cm (0.8-2.1). The mean maximal length of the lesion was 0.8 +/- 0.4 cm (0.3-1.8). The following were the most frequent ultrasonographic findings of lesions: irregular shape, not parallel orientation, indistinct margins, abrupt interface, hypoechogenicity, no posterior feature, no calcification, and presence of vascularity. The most frequent BI-RADS category was 4a. There were no suspicious findings on the mammography or MRI. CONCLUSION: Ultrasonographic findings may lead to misclassification of band-like interposing fat as a malignancy. A better understanding of the clinical and ultrasonographic characteristics of band-like interposing fat would facilitate its differentiation from a true mass.
Adipose Tissue/*ultrasonography ; Adult ; Biopsy, Fine-Needle ; Breast Diseases/pathology/*ultrasonography ; Diagnosis, Differential ; Diagnostic Errors ; Female ; Humans ; Mammary Arteries/*ultrasonography ; Middle Aged ; Pregnancy ; Retrospective Studies ; Ultrasonography, Mammary/*methods ; Young Adult

BACKGROUNDS: The internal mammary artery graft (IMAG) showed a gradual transition in the phasic flow pattern from predominant systolic velocity proximally at the origin from the subclavian artery to the predominant diastolic velocity distal to the anastomosis with coronary artery. IMAG without significant stenosis showed a typical pulsed Doppler flow pattern similar to that of coronary artery characterized by a predominant diastolic component. On the other hand, patients with occluded IMAGs or IMAGs with severe stenosis, low velocity profiles were recorded during diastole with an increase in the systolic component. OBJECTIVES: Identifying abnormal graft flow intraoperatively could allow for immediate graft revision. The aim of this study was to test the feasibility of using a new ultrasound 15 MHz linear array transducer. METHODS: In six patients (M:F=4:2, mean age=69+/-11 yrs), a 15 MHz linear array probe with a sterile cover was placed directly on native coronary arteries and grafts after anatomosis. 2-dimensional image, color and pulsed Doppler signals of native coronary arteries, IMA, saphenous vein and penetrating intramyocardial coronary arteries (PICA) were observed. RESULTS: 1) 2-dimensional image and color flow signals of all grafts and native coronary arteries were visualized. 2) The flow pattern of pulsed Doppler signals of all native coronary arteries including PICA were diastolic dominant. 3) The diastolic dominant pattern typical of a patent grafts on pulsed Doppler were obtained at anastomosis site of graft vessels. 4) The intimal thickening of right coronary artery was also visualized on 2-dimensional images. CONCLUSION: A new echo Doppler probe can be useful for intraoperative assessment of graft flow during bypass surgery.
Blood Flow Velocity ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Vessels* ; Diastole ; Echocardiography ; Hand ; Humans ; Mammary Arteries ; Monitoring, Intraoperative ; Pica ; Saphenous Vein ; Subclavian Artery ; Transducers* ; Transplants* ; Ultrasonography